11. Communicating with the Dental Laboratory Flashcards by J L

Dentist Guidelines
n Provide ____ instructions to laboratory (and retain duplicate)
nClearly written and understandable
nDetail work to be performed
nDescribe materials to use n Coloration
n Written description, photograph, drawing, shade tab

written

How well did you know this?

Not at all

Perfectly

Dentist Guidelines
n Provide accurate:
n ____
n Casts
nOcclusal ____ nMounted casts (where indicated)
n Dentist should identify crown ____ (where indicated)
n Dentist should properly clean and ____ all items before sending

impressions
registrations
margins
disinfect

How well did you know this?

Not at all

Perfectly

Technician Guidelines
nTechnician should follow guidelines of written instructions from dentist
nTechnician should ____ written instructions
nWritten instruction forms provided by the lab should include ample ____ for dentist􏰆s written instruction
nTechnician should return case to check ____, if possible inaccuracy

retain
space
mounting

How well did you know this?

Not at all

Perfectly

Technician Guidelines
nTechnician should match ____ indicated
nTechnician should return work in a timely manner
nTechnician should follow ____ control standards

shade

infection

How well did you know this?

Not at all

Perfectly

Work Authorization

n General description of restoration to be made n Material specification
n Desired occlusal scheme
n Location of \_\_\_\_
n Specify \_\_\_\_ or metal contacts
n Diagnostic \_\_\_\_ helpful for scheme
n \_\_\_\_ design for fixed dental prosthesis n Cast vs. post-ceramic soldered
n \_\_\_\_ and substructure design
n Including \_\_\_\_ for tissue contact

occlusal contacts
porcelain
wax-up
connector
pontic
material

How well did you know this?

Not at all

Perfectly

Work Authorization
n Substructure design for metal ceramic restorations
n Indicate if want to see entire ____ before cutback n Shade selection
n ____ of tooth helpful
n Custom shade tab
n ____ shade analysis
n Photograph
n Technician may see patient with dentist (where ____)
n Date of next scheduled patient ____ and stage of ____ required

wax up
diagram
digital
lawful
appointment
completion

How well did you know this?

Not at all

Perfectly

Work Authorization

n Shade distribution chart must be adequate to include details
nSubtle \_\_\_\_ differences
n \_\_\_\_ 
n \_\_\_\_
n \_\_\_\_

shade
hypocalcification
translucency
stains

How well did you know this?

Not at all

Perfectly

Work Authorization
n Additional information
nDiagnostic waxing 
nCasts of provisional
restorations
n \_\_\_\_
n \_\_\_\_ edge position
n \_\_\_\_ form 
nDigital images

midlines
incisal
coronal

How well did you know this?

Not at all

Perfectly

Problems
n Most common problems seen by dentist
nPoor \_\_\_\_ adaptation
nPoor \_\_\_\_ nPoor \_\_\_\_ contour
n Overcontouring of cervical 1/3
nHaphazard \_\_\_\_ and substructure design

marginal
occlusion
axial
pontic

How well did you know this?

Not at all

Perfectly

Problems
n Most common problems seen by technician
nInadequate \_\_\_\_ reduction
n Esp. \_\_\_\_ 
n 􏰆mystery
\_\_\_\_􏰇 
n Improper
\_\_\_\_
nVagueness in \_\_\_\_ communication

tooth
cervical 1/3
margins
articulation
color

How well did you know this?

Not at all

Perfectly

Interim Cementation

n Sometimes recommended so patient and dentist could assess appearance and ____ over time
n Manage cautiously
nOften difficult to ____
n May mix interim cement with ____
n May apply only at ____
nMay loosen during function. If loosens:
n Uncomfortable/embarrassing for patient
n May result in ____ if patient does not
return (especially if an abutment loosens)
n Patient needs instructions regarding objectives, duration and importance of returning

function
remove
petrolatum
margins
caries

How well did you know this?

Not at all

Perfectly

Interim Cements
Main Clinic
nTemp Bond NE (Kerr)
nFynal (Denstply) in ADCC (honors)
n\_\_\_\_ final cement nDycal (Dentsply) nIRM (Dentsply)
nDurelon (3M/ESPE)
n May use as \_\_\_\_ interim cement
2018

ZOE

long term

How well did you know this?

Not at all

Perfectly

Introduction

nDefinitive cementation does not receive same attention to detail as other aspects of restorative dentistry
nCareless luting selection ____ discrepancies nImproper ____
nMay require ____ restoration off and remaking

margin
occlusion
cutting

How well did you know this?

Not at all

Perfectly

Choice of Luting Agent
n Depends on ____ casting or adhesively bonded restoration
n Ex. Ceramic inlay or resin bonded FDP
n (1)Traditional water-based dental cements n Use for ____ and FDPs
n Not used where ____ is needed

n (2)Adhesive resins
n Necessary for some restorations
n ____ sensitive and can be difficult to use (newer self-etch formulations easier)
n Long term data justifying more general use with ____ limited

conventional
cast crowns
adhesion

technique
conventional castings

How well did you know this?

Not at all

Perfectly

Dental Cements

n Most luting agents traditionally used for cast restorations are ____
n Susceptible to acid attack making them somewhat soluble in ____ fluids
n In vitro studies show this is independent of marginal ____ (up to certain critical value)
n Dissolution is mechanism in cement ____ (not disintegration)

cements
oral
width
erosion

How well did you know this?

Not at all

Perfectly

(1)Zinc Phosphate Cement
n Still used for \_\_\_\_ restorations
n Adequate strength
n Acceptable \_\_\_\_ thickness
(25um)
n Reasonable working time
n Excess material easily \_\_\_\_ n \_\_\_\_ effects on pulp are well
documented (phosphoric acid)
n Take normal precautions
n Not used when preparation is too close to \_\_\_\_

cast
film
removed
toxic
pulp

How well did you know this?

Not at all

Perfectly

(1)Zn Phosphate Cement
Choice of Luting Agent

nDespite limited biocompatibility due to pulp irritation > long history of ____ (important!)
n Cavity ____ may protect pulp with no decreased retention
nRemains good option for luting restorations on otherwise normal, conservatively prepared teeth
nCrowns displayed increased resistance to ____ on preparations with minimal resistance form

success
varnish
dislodgement

How well did you know this?

Not at all

Perfectly

(1)Zinc Phosphate Cement
n Examples
n____ (Mission)**

zinc cement

How well did you know this?

Not at all

Perfectly

(2)Zinc Polycarboxylate Cement

n Biocompatible
n Large polyacrylic acid molecule does ____ penetrate
dentinal tubules

n Exhibits ____ to tooth
n Due to ____ chelation
n No adhesion to ____

n High viscosity makes mixing ____
n May use encapsulated products

n Claims of ____ long term retention
n May adversely change properties by adjusting powder/liquid ____
n ____ Powder/liquid ratio ____ solubility
n Also improved with encapsulated products

not
adhesion
calcium
castings

difficult
inferior
ratio
decrease
increase

How well did you know this?

Not at all

Perfectly

(2)Zinc Polycarboxylate Cement

n Working time much shorter than ____
n 2.5 min compared to 5 min
n Problem with ____ units

n Residual cement more difficult to ____ than Zn phosphate
n Some studies show less ____ than Zn phosphate
n Limit to restorations with good retention and resistance
form where minimal ____ irritation is wanted
n May use as a base and to block out minor ____ on vital teeth
n Chemical interaction with ____
n Contraindicated cementing crowns on Ti abutments

Zn phosphate
multiple
remove
retention
pulp
undercuts
titanium (Ti)

How well did you know this?

Not at all

Perfectly

(2)Zinc Polycarboxylate Cement
Choice of Luting Agent
nRecommended on retentive preparations when minimal pulp irritation is important
nEx. Children with ____ pulp chambers

large

How well did you know this?

Not at all

Perfectly

(2)Zinc Polycarboxylate Cement
n Examples
n ____ (3M/ESPE)**

**Main clinic: Use for ____ cementation

durelon

temporary

How well did you know this?

Not at all

Perfectly

(3)Glass Ionomer Cement

n Adheres to enamel and \_\_\_\_
n Exhibits good \_\_\_\_
n Releases \_\_\_\_
n May have anticariogenic effect
n Has NOT been documented \_\_\_\_! 
n Set exhibits \_\_\_\_
n Advantageous with porcelain labial \_\_\_\_

n Mechanical properties ____ to zinc
phosphate and polycarboxylate cements

n ____ appearance when set
n Difficult to distinguish between ____ caries
n Difficult to distinguish ____

dentin
biocompatibility
clinically
translucency
margins

superior
radiolucent
recurrent
overhang

How well did you know this?

Not at all

Perfectly

(3)Glass Ionomer Cement
n Susceptible to moisture ____ during setting

n protect with foil, resin coat or band of cement undisturbed for ____ minutes
nWater changes setting reaction resulting in water absorption > ____
nDo not ____ during initial setting
n Newer resin modified ____ ionomers are less susceptible to early moisture exposure

contamination
10
erosion
dessicate
less

How well did you know this?

Not at all

Perfectly

(3)Glass Ionomer Cement n Post operative ____ reports have not been demonstrated in clinical trials nLittle ____ response found histologically n May be due to dessication or ____ contamination nEvaluate technique if sensitivity nResin modified and self-adhesive resins show less post operative ____ nDesensitizing agent may prevent ____ n may decrease ____

``` sensitivity pulpal bacterial sensitivity sensitivty retention ```

(3)Glass Ionomer Cement Choice of Luting Agent nPopular cement for luting ____ restorations nGood working properties nMore ____ than zinc phosphate nSets more ____ than zinc phosphate nEasily ____

casting translucent rapidly mixed

(3)Glass Ionomer Cement n Examples n ____**, Ketac-Cem Aplicap (3M ESPE)

ketac-cam

(4)Zinc Oxide-Eugenol with and without Ethoxybenzoic Acid ``` nReinforced ZOE extremely ____ nProvides excellent ____ nLimited use due to inferior properties nCompressive ____* n ____* nFilm ____* --- all inferior to other luting agents (i.e Zn phosphate) ```

``` biocompatible seal strength solubility thickness ```

(4)Zinc Oxide-Eugenol with and without Ethoxybenzoic acid n Ethoxybenzoic acid (EBA) modifier replaces portion of ____ in ZOE nImproves ____ strength without affecting resistance to ____ n ____ working time n Excess material difficult to ____ n Use only in restorations with ____ retention form n When emphasis on ____ and pulpal protection needed n Main clinic: ____ (Dentsply)

``` eugenol compressive deformation short remove good biocompatibility fynal ```

(5)Resin-Modified Glass Ionomer Luting Agents n Developed in 1990s nCombine desirable properties of glass ionomer (____ release and adhesion) with higher ____ and low ____ of resins n Less susceptible to early ____ exposure than glass ionomer n Among the most ____ cements n Minimal postcementation sensitivity n Higher strength than ____ cements (similar to resin luting agents) n Avoid with ____ restorations nAssociated with ____ due to water absorption and expansion

``` fluoride strength solubility moisture popular conventional all-ceramic fracture ```

(5)Resin-Modified Glass Ionomer Choice of Luting Agent nAmong the most popular nLow ____ n ____ nLow ____ nPerceived benefit of reduced post cementation ____ nNot confirmed in clinical studies

solubility adhesion microleakage sensitivity

(5)Resin-Modified Glass Ionomer Luting Agents n Examples ____ (3M ESPE)** nFuji Plus (GC America, Inc.)**

RelyX

(6)Resin Luting Agents nEarly products unsuccessful (1950s) nhigh polymerization ____ npoor ____ nComposite resin cements with improved properties developed nUsed for ____ ceramics nHave ____ properties n Capable of bonding chemically to ____

``` shrinkage biocompatibility bonded adhesive dentin ```

(6)Resin Luting Agents nImproved properties and lack of ____ increased use nLess ____ than cements nEx. Glass ionomer nEspecially if not fully ____ n____ resins have lowest incidence of postcementation sensitivity

solubility biocompatible polymerized self-adhesive

(6)Resin Luting Agents n Categorized on basis of n____ method and presence of n____ bonding mechanisms n Chemical-cure, light-cure, dual-cure n Metal restorations n____ cured system n Ceramics n____-cured or n____-cured n adhesive scheme classification n n____ etch (etch, adhesive, cement) n n____ etch (primer and cement) n Self n____ (one step)

polymerization dentin ``` chemically light dual total self adhesive ```

(6)Resin Luting Agents Choice of Luting Agent nHigh n____ strength nConcern regarding stresses caused by polymerization shrinkage, magnified in n____ films, lead to marginal leakage nSelf etch systems increasingly popular nSimplicity of traditional cements nReduced n____ of traditional adhesive resins nPatients appear to experience n____ incidence of post treatment n____

``` retention thin solubility lowest sensitivity ```

``` (6)Resin Luting Agents Choice of Luting Agent n Indications n____ and ____ processed composite resin restorations nWhen casting has been displaced due to lack of ____ ```

all-ceramic laboratory retention

``` Resin Luting Agents Main Clinic n Panavia V5 +Ceramic Primer (Kuraray) n ____ cure n ____ releasing n Panavia SA (Kuraray) n ____ adhesive/self etch n Clearfil esthetic cement (Kuraray) n ____ cure n Nexus III (Kerr) n ____ cure ``` ``` n Variolink (Ivoclar) n ____ cure n ____ cure n Relyx Unicem (3M Espe) n ____ cure/Self adhesive ```

``` dual fluoride self dual dual light dual light dual ```

``` Choice of Luting Agent Ideal luting agent nLong ____ time n Adheres well to both tooth structure and restorative materials nProvides a good seal n____ to pulp nAdequate strength properties nCompressible into ____ layers nLow viscosity and solubility nExhibits good working and setting characteristics nExcess easily ____ ```

working nontoxic thin removed

No single luting agent meets all of the ____ properties

ideal

``` Procedure Preparation of Tooth and Restoration n Decreased performance of luting agents if material is ____ nWater, blood, saliva nRestoration and tooth must be carefully ____ and dried ```

contaminated | cleaned

``` Procedure Rosenstiel SF et al., 2016 Preparation of Tooth and Restoration n Casting preparation n Clean n ____ cleaning n ____ n Organic solvents nAirborne particle abrasion of internal surface n 50um ____ n Increases retention of ____ ```

steam ultrasonics alumina casting

``` Procedure Preparation of Tooth and Restoration n Tooth preparation nremove interim luting agent nDo not ____ teeth (post operative sensitivity) nClean tooth n Pumice and/or chlorhexidine preparation (Consepsis) ____ dry ```

dessicate | gently

Procedure n Inspect preparation surfaces for cleanliness n Isolate area with cotton rolls and place saliva evacuator n May coat with cavity ____ or dentin bonding resin for ____ cement only n ex. ____ n Mix cement according to manufacturers􏰆 guidelines

varnish non-adhesive zinc phosphate

Procedure n Apply thin coat of cement to clean restoration n Be certain tooth is dry and push restoration into place n ____ seating force n Excess cement will escape from margins

rocking

Procedure n Applying an orangewood stick with a ____ motion (or cotton roll) against the restoration ensures that all excess cement is expressed n Avoid ____ force

rocking | excessive

Procedure n After casting is seated, check margins to verify restoration is fully in place n May protect setting cement by covering with ____ nEx. Dryfoil

adhesive foil

Procedure n When cement is fully ____, remove excess with explorer nMay compromise cement integrity if remove too ____ n Dental floss with a ____ may be used to remove interproximal cement

set early knot

Procedure n The sulcus should contain no cement once completed n Check occlusion with ____ stock n Cements take at least ____ hours to develop final strength nChew carefully for ____ days

shim 24 1-2

Procedure Resin Luting Agents n Resin cement (Panavia) is dispensed and spatulated n Cement sets if ____ is excluded, so should be spread over ____ surface

oxygen | large

Procedure Resin Luting Agents n Cement is coated with ____ gel to promote polymerization

oxygen-inhibiting

Preclinical Procedure Cement #19 (Ketac Cem) nPrepare tooth nDab tooth dry with cotton pellets n(pulpal protection when close to pulp) nShake bottle to loosen powder n1 level spoonful of powder:____ drops liquid nPlace powder and liquid on mixing pad or glass slab nMix using metal or plastic spatula nAdd powder to liquid in one portion

Preclinical Procedure Cement #19 (Ketac Cem) nContinue to smooth out paste until homogenous mixture is obtained nApply thin coat of cement to inside crown (avoid overfilling crown) n Times nMixing: ____ min n Application (incl. mixing): ____ min. 30 sec. nSetting from beginning mix: ____ minutes nRemove excess after ____ minutes

1 3 7 7

Summary nProper ____ control is essential for cementation nRestoration must be carefully prepared for cementation nAir ____ is recommended nSeat restoration using rocking motion nLuting agent must be protected from ____ during initial setting

moisture abrasion moisture

Introduction n After placement and cementation of fixed dental prosthesis, patient treatment continues with carefully structured ____ of postoperative appointments

sequence

Introduction n After placement and cementation of fixed dental prosthesis, patient treatment continues with carefully structured ____ of postoperative appointments

sequence

``` Introduction n Postoperative appointments nMonitor patient’s dental health n Stimulate meticulous ____ control habits nIdentify incipient disease nIntroduce ____ treatment, if needed ```

plaque | corrective

Introduction n Patients should be instructed in special plaque control measures nEspecially around ____ and connectors n Need to educate regarding use of oral hygiene aids nEx. ____ threaders

pontics | floss

Postcementation Appointments n Appointment ____ days after FDP insertion n To enable dentist to monitor function and comfort of prosthesis n Verify proper plaque control n Check sulcus for residual cement n Check occlusion

7-10

Recall Appointments n Especially important for patients with ____ restorations n Should be carried out by ____ n Detecting disease around FDP difficult n Partial dissolution of luting agent may be difficult to diagnose with ____ margins n Often caries goes undetected until ____

extensive dentist subgingival symptomatic

Recall Examinations n If caries is overlooked, disease may rapidly progress nNew ____ may be needed nTooth loss may ____

prosthesis | result

Recall Appointments n For cast restorations, should minimally be every ____ months n If more extensive rehabilitation, more ____ appointments n Can be coordinated with restorative dentist or ____ n Establish who will assume primary responsibility to coordinate appointments

6 frequent periodontist

``` Recall Appointments nHistory and general examination nOral hygiene, diet and saliva nDental caries nIncluding ____ caries nPeriodontal disease nOcclusal dysfunction nPulp and periapical health ```

root

``` Emergency Appointments n ____ nLoose abutment retainer n Fractured ____ nFractured veneer ```

pain | connector

Summary nWell-organized and efficient postoperative care is important to ensure optimal longevity and success in fixed prosthodontics nA restoration which is neglected, is likely to fail regardless of quality of restoration ____ teeth require more meticulous plaque removal and maintenance than healthy teeth nA fixed dental prosthesis requires additional care and attention

restored

Summary nCommon complications after treatment ____, periodontal failure, ____ failure, loose retainers, porcelain fracture, root fracture nDentist should anticipate long term prognosis and treatment needs and design treatment plan accordingly nThe patient must understand the limitations of ____ before treatment begins

caries endodontic fixed prosthodontics